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Chapter 4 | The impact of the crisis on the health system and health in Greece
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4.5 Transparency and accountability
Before the economic crisis, a number of institutions were tasked with
combating corruption and ensuring transparency and accountability in
public administration and the health care sector. These include the General
Inspector of Public Administration, the Body of Inspectors for Health and
Welfare Services (SEYYP) and the Ombudsman of Health and Welfare as
well as YPEDYFKA, the agency that monitors social health insurance funds'
expenditure. Although these institutions have seriously tried to achieve their
mandates, their effectiveness has been limited, mainly because of the incentives
for unethical behaviours and opacity promoted by the health system's structural
deficiencies. These deficiencies include
• a lack of information for health service users;
• long waiting lists because of unequal and inefficient allocation of human
and economic resources and of facilities;
• ineffective managerial structures, lacking adequate information management
systems and in many cases staffed by personnel who do not have the right
managerial skills;
• limited administrative capacity;
• lack of coordination among the large number of payers;
• absence of adequate financial management and accounting systems;
• lack of monitoring processes and supervision mechanisms;
• irrational pricing and remuneration policy; and
• low health professionals' salaries that are not related to their performance.
Some of the reforms introduced after 2010 are expected to have a direct effect
on transparency and accountability. Under Law 3892/2010, all physicians
associated with the social security institutions, doctors working in public
health service units as well as pharmacists, were required to register with the
e-prescription system and enter the required prescription electronically. Later,
the use of e-prescribing for all other medical acts (referrals, diagnostics, surgery)
was expanded to all NHS facilities. Moreover, a comprehensive range of positive
measures have been implemented to increase monitoring and make financial
transactions within the health system more transparent (see section 3.3).
Last, but not least, the Clarity Programme promotes transparency and openness of
the Greek Government and its policies (Diavgeia, https://www.diavgeia.gov.gr).
Since October 2010, all ministries, public institutions, regulatory authorities
and local governments have been obliged to upload their decisions onto the
Internet, and, henceforth, these decisions, including those in the health sector,
cannot be implemented if they are not uploaded on the Diavgeia web site.
These measures may have positive long-term effects provided that additional
attention is given to their full implementation.